Endoscopic extraperitoneal radical prostatectomy

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The endoscopic extraperitoneal radical prostatectomy (abbreviation EERPE ) is a minimally invasive surgical procedure for complete removal of the prostate . This special form of prostatectomy is mainly used to remove the prostate in localized prostate cancer .

description

The EERPE is carried out in a minimally invasive manner. To do this, five small incisions are usually made in the patient's skin below the navel, through which the surgeon (a urologist) inserts the instruments and a camera into the pelvis. The rectus abdominis muscle is pushed apart and a specially shaped balloon trocar develops the preperitoneal space , which lies between the peritoneum (peritoneum), the abdominal wall in the suprapubic area and the transversalis fascia , the back of the abdominal wall muscles. The peritoneum and the parts of the intestine behind it are pushed back by the balloon trocar. By blowing in carbon dioxide (CO 2 - insufflation ) an artificial cavity is provided in the pre-peritoneal space, the instruments and the camera are inserted into the. The camera transmits the image of the operating field to a monitor near the surgeon. After the prostate has been removed, the two parts of the urethra are reconnected ( anastomosis ). This connection must be watertight. After the prostate and anastomosis have been removed, lymph nodes in close proximity to the prostate can be removed. If further lymph nodes, for example in the pelvis ( pelvis minor ), have to be removed, this must be done in a second step via a separate access.

Usually seven days after the operation, the success of the anastomosis is checked with the help of cystography and the urethral catheter is removed again.

Thanks to the minimally invasive design, patients who have had an EERPE convalescent faster than patients who have had a conventional radical prostatectomy. EERPE can also be performed in a nerve-friendly manner, i.e. with the aim of maintaining the function of the cavernous nerves . The cavernous nerves are of great importance for the erection of the penis.

Endoscopic extraperitoneal radical prostatectomy is a comparatively new surgical procedure. It was developed in 1999 at three different clinics. In comparison, the classic perineal radical prostatectomy was performed for the first time in 1904 by Hugh Hampton Young .

A further development of the EERPE is the so-called Da Vinci laparoscopy , in which the surgeon carries out the minimally invasive procedure to remove the prostate via a console that is very similar to a computer workstation.

Possible complications

In principle, with all radical prostatectomy procedures, significant side effects are possible after the removal of the prostate. These side effects are described in the main article Prostatectomy. The complications specific to EERPE are described below.

Typical complications after EERPE are mainly vascular injuries that can lead to bleeding and hematomas . In addition, injuries to the intestine , lymphoceles , injuries to the bladder or ureter, hernias in the area of ​​the laparoscope access , anastomotic leakage or stricture , injuries to the obturator nerve up to paralysis , gas embolism , catheter blockage, pubic bone inflammation and infections such as urosepsis are described as possible complications.

further reading

Individual evidence

  1. ↑ a b c d Endoscopic extraperitoneal radical prostatectomy (EERPE). ( Memento of the original from November 3, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Urological Clinic and Polyclinic of the Ludwig Maximilians University in Munich, accessed on December 31, 2011  @1@ 2Template: Webachiv / IABot / www.klinikum.uni-muenchen.de
  2. ↑ JU Stolzenburg, R. Rabenalt a. a .: Nerve-sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique. In: Journal of endourology / Endourological Society. Volume 20, Number 11, November 2006, pp. 925-929, ISSN  0892-7790 . doi : 10.1089 / end 2006.20.925 . PMID 17144866 .
  3. ↑ J. Rassweiler, O. Seemann u. a .: Technical evolution of laparoscopic radical prostatectomy after 450 cases. In: Journal of endourology / Endourological Society. Volume 17, Number 3, April 2003, pp. 143-154, ISSN  0892-7790 . doi : 10.1089 / 089277903321618707 . PMID 12803986 .
  4. ↑ A. Baars, K. Heine et al.: Prostate carcinoma surgery in urology goods. In: Ärzteblatt Mecklenburg-Vorpommern. Volume 21 number 4, 2011, pp. 119-122.
  5. ↑ A. Häglsperger: Identification of risk groups for PSA relapse in localized prostate cancer after radical prostatectomy . Dissertation, Technical University of Munich, 2006, p. 23.
  6. ↑ The da Vinci® surgical system. ( Memento of the original from December 21, 2011 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Manufacturer's website.  @1@ 2Template: Webachiv / IABot / www.davincisurgery.com
  7. ↑ JU Stolzenburg, R. Rabenalt a. a .: Complications of endoscopic extraperitoneal radical prostatectomy (EERPE): prevention and management. In: World journal of urology. Volume 24, Number 6, December 2006, pp. 668-675, ISSN  0724-4983 . doi : 10.1007 / s00345-006-0133-8 . PMID 17086396 . (Review).
  8. ↑ E. Liatsikos, R. Rabenalt a. a .: Prevention and management of perioperative complications in laparoscopic and endoscopic radical prostatectomy. In: World journal of urology. Volume 26, Number 6, December 2008, pp. 571-580, ISSN  0724-4983 . doi : 10.1007 / s00345-008-0328-2 . PMID 18781306 . (Review).

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